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Efficacy of Quichua healers as psychiatric diagnosticians

  • Mario Incayawar (a1)
Summary

Traditional healers' practices are widespread around the world, yet their diagnostic skills have rarely been investigated. This exploratory study examines whether yachactaitas (Quichua healers) in the Andes identify cases of psychiatric illness in their communities. For over 18 months, ten yachactaitas participated in the identification of 50 individuals with the condition known as llaqui. Medical and psychiatric evaluation indicated that most of those so diagnosed had a DSM–III–R mental disorder. None of the participants with llaqui was considered healthy in biomedical or psychiatric terms. It is suggested that yachactaitas might indeed identify general psychiatric cases in their communities, and that this might be useful for screening purposes.

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Copyright
Corresponding author
Dr Mario Incayawar, Director, Runajambi Institute for the Study of Quichua Culture and Health, Otavalo, Ecuador. E-mail: inca@runajambi.org
Footnotes
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Declaration of interest

None.

Funding detailed in Acknowledgements.

Footnotes
References
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1 Bogoras, W. The Chukchee. American Museum of Natural History, 1907.
2 Kleinman, A. Patients and Healers in the Context of Culture: An Exploration of the Borderland Between Anthropology, Medicine, and Psychiatry. University of California Press, 1980.
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7 Jilek, WG. Indian Healing: Shamanic Ceremonialism in the Pacific Northwest Today. Hancock House, 1982.
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14 Incayawar, M. Indigenous peoples of South America – inequalities in mental health care. In Culture and Mental Health: A Comprehensive Textbook (eds Bhui, K & Bhugra, D): 185–90. Hodder Arnold, 2007.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Efficacy of Quichua healers as psychiatric diagnosticians

  • Mario Incayawar (a1)
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eLetters

Quichua healers and the identification of mental illness

Ruth V Reed, Specialty Registrar in Psychiatry
08 August 2008

Incayawar’s research appears to indicate that traditional Quichua healers have a perhaps surprisingly successful ability to identify those with psychiatric and physical illness in their rural communities. Incayawar states that none of the sample of llaqui cases were fully healthy from a Western medical or psychiatric perspective, as 82% fulfilled DSM-III-R criteria for depressive disorders, and 80% had parasitic and infectious diseases. I undertook my medical elective in a similar rural highland Quichua area in neighbouring Peru in 2002, and would like to make several observations on his findings.

One must consider that there are several factors which deliver to thetraditional healer a pre-selected group of ‘patients’ who have a very highchance of being genuinely unwell in Western terms, irrespective of the healer’s own skill in identifying them as ill. I found that infection withparasites in the jungle highlands was essentially universal and all healthcare staff and affluent patients would regularly test and treat themselves, invariably becoming reinfected and symptomatic within a coupleof months - thus, it is not surprising that all of the identified ‘cases’had at least one diagnosable condition. Life in such areas of the Andes is very physically challenging, and journeys from village to village can be a matter of days. The cases in the sample, male or female, would all have had to work hard for the survival of their families, and taking time out from these responsibilities to seek treatment would not be undertaken lightly, particularly as other family members would probably need to be involved. The degree of illness and its effects on the person’s fulfilment of dutieswould therefore be quite significant and of concern to more than the individual themselves before outside help was sought. The individual, family and community are therefore acting as a moderately effective screening tool in themselves.

The supernatural beliefs and different categories of llaqui are an explanatory cultural framework that proves confusing to the Western-trained practitioner, but in its essence Llaqui as a concept involves self-identified sadness and the co-existence of adverse life events such as the death of a relative. It is not, then, so surprising that healers using these criteria should be able to select out individuals with sadnessthat we would identify as a depressive illness.

Dr Ruth V Reed

Specialty Registrar in Psychiatry, Berkshire Adolescent Unit, Wokingham Hospital, Barkham Road, Wokingham, Berkshire, RG41 2RE.

Declaration of Interest: No conflict of interest to declare.
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Conflict of interest: None Declared

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